HomeMy WebLinkAboutRazzaneseJUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
FAX (516) 765-1823
TELEPHONE (516) 765-1801
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1469-R Residential X Non -Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RAZZANESE, RON
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Mailing Address 1 HAWTHORNE, SUE
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Mailing Address 2 29 ARDEN ROAD
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City St Zip WATERTOWN MA 02172-0000
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Property Address 1 400 RICHMOND ROAD EAST
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 617-924-3689
Tax Map No. section 135.00 block 3 lot 8.000
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Cross Street NORTH ROAD (C.R. 48)
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Date Of Last Pump Out 0/00/00
Issue Date: 5/23/90
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Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
Application No.
$10.00 - Residential
$25.00 - Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Operation Permit No.
Fee $ A® y
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
DATE
OWNER NAME:
OWNER MAILING ADDRESS: �9 ftwo&yloco
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-OWNER PROPERTY ADDRESS: 40oI
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OWNER TELEPHONE "NUMBER: Gs % p, -k.( ice 9 !rl ��G,SS9a!r
TAX MAP NO.: Section 0 3 Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool O` New Existing
Residential ® Non -Residential
DATE OF PREVIOUS PUMP -OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
RECEIVED BY:
Town Clerk's Office
DATE:
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jpWure of Applicant
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